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对 2022 年暴发期间来自 13 个国家的 101 例猴痘(猴痘)病例的皮肤科评估:皮肤损伤形态、临床过程和瘢痕形成。

A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring.

机构信息

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Icahn School of Medicine, The Mount Sinai Hospital, New York, New York.

Department of Dermatology, University Hospital Mostoles, Madrid, Spain; Fundación Lluita contra les Infeccions, Hospital Germans Trias i Puyol, Badalona, Barcelona, Spain.

出版信息

J Am Acad Dermatol. 2023 May;88(5):1066-1073. doi: 10.1016/j.jaad.2022.12.035. Epub 2023 Jan 11.


DOI:10.1016/j.jaad.2022.12.035
PMID:36641010
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9833815/
Abstract

BACKGROUND: In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. OBJECTIVE: The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. METHODS: The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. RESULTS: From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. LIMITATIONS: Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. DISCUSSION: These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela.

摘要

背景:在 2022 年猴痘(猴痘)疫情中,已报告全球病例 79000 例。然而,关于病变形态和进展,发表的皮肤科数据有限。

目的:本研究旨在描述猴痘感染随时间推移的皮肤病变形态、症状和结局。

方法:美国皮肤病学会/国际皮肤科联盟皮肤病 COVID-19、猴痘和新兴传染病登记处收集了由医疗保健专业人员输入的、关于猴痘的匿名患者病例。

结果:从 2022 年 8 月 4 日至 11 月 13 日,来自 13 个国家的 101 例病例被输入,主要由皮肤科医生(92%)输入。39%的病例病变少于 5 个。在 54%的病例中,皮肤病变是感染的第一迹象。在感染的第 1-5 天,丘疹(36%)、水疱(17%)和脓疱(20%)占主导地位。在第 6-10 天,脓疱(36%)最为常见,其次是糜烂/溃疡(27%)和结痂/鳞屑(24%)。第 11 天后,结痂/鳞屑是主要的病变形态。报告了 10 例麻疹样皮疹病例。13%的病例发生了瘢痕形成。

局限性:登记处报告的数据不能解决发病率问题。由于倾向于报告临床严重程度较高的病例,可能存在报告偏倚。

讨论:这些发现突出了与历史疫情相比皮肤表现的差异,特别是在出现全身症状之前存在皮肤病变,以及病变总数较低。瘢痕形成是一个主要的潜在后遗症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/08b35bdf0628/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/58ed643d5c48/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/b04e670a1c44/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/08b35bdf0628/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/58ed643d5c48/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/b04e670a1c44/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5089/9833815/08b35bdf0628/gr3_lrg.jpg

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[3]
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[4]
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[5]
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[6]
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[7]
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Microorganisms. 2024-12-13

[8]
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J Trop Med. 2024-12-30

[9]
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[10]
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本文引用的文献

[1]
Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022.

MMWR Morb Mortal Wkly Rep. 2022-11-4

[2]
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BMJ. 2022-11-2

[3]
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BMJ. 2022-11-2

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Reasons for hospitalization of patients with monkeypox: a quantitative evidence synthesis.

Infection. 2023-6

[5]
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Lancet. 2022-8-27

[6]
Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases.

Br J Dermatol. 2022-11

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Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series.

BMJ. 2022-7-28

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Open Forum Infect Dis. 2022-6-23

[9]
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N Engl J Med. 2022-8-25

[10]
Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash.

N Engl J Med. 2022-8-11

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